Performance of Public Hospitals in Kenya: the essential role of management

Abstract

Background: Most African governments have made commitments to provide universal health coverage as a human right and to reduce inequalities in health outcomes among their citizens. Achieving these goals requires increased investment in health facilities and greater outlays on ways to improve management practices that will ensure efficient and effective use of available resources so as to attain the intended health goals. Only a limited number of studies in Kenya have assessed the association between management practices and performance of hospitals and other health facilities. This study identified the key management practices in usage in public hospitals in Kenya, and assessed the association between these practices and hospital performance with regard to quantity and quality of care, patients’ satisfaction with the care offered, and with regard to health outcomes achieved by hospital managers. Data and Methods: We collected primary data from 25 hospitals in the central region of Kenya using cross sectional mixed methods, meaning that quantitative and qualitative data collection approaches were used at a given point in time, i.e., 2015. The sample size was 790 patients (400 outpatients and 390 inpatients) and 75 hospital managers. We applied data envelopment analysis (DEA), as the efficiency estimating method, and the OLS and Tobit estimation techniques to analyze determinants of variations in performance efficiency across hospitals. Results: The study identified eleven commonly used hospital management practices in Kenya that had varying effects on public hospitals’ performance. The identified management practices included delegation with follow up; work plans implementation; effective communication; and empowerment of staff. These were found to significantly increase total outpatient visits by at least 49% and total patient admissions by at least58%, thus enhancing hospital performance and increasing the quantity and quality of health care delivered. Consensus building, consultation among health professionals, and hospital residence of senior management staff were found to be significantly and positively associated with quality service delivery, as well as with better health outcomes. Conclusion and policy implications: The thesis has shown that good management practices improve hospital outputs, increase patients’ satisfaction with services and raise hospital productivity. Residence within compounds of health care facilities by the top hospital managers, plus continuous monitoring and evaluation of staff performance, are some of the key policy measures that the government of Kenya can adopt for quick gains in hospital performance and achieve better health outcomes for all citizens.